Background: The concept of client-centred practice (CCP) was first developed and implemented
by occupational therapists in Canada during the early 1980s and subsequently transferred into
the Tanzanian occupational therapy curriculum by international volunteer educators. Currently,
the occupational therapy curriculum at the Kilimanjaro Christian Medical University College
(KCMUCo) in Moshi, Tanzania covers CCP using assessment tools and models developed by the
Canadian Association of Occupational Therapy. To date, no occupational therapy research has
been conducted to investigate the relevance of CCP for Tanzania, or to document the
perspectives of therapists in applying the principles of CCP. This study was indicated to inform
the occupational therapy curriculum at the KCMUCo and the Tanzania Occupational Therapy
Association (TOTA) about occupational therapy practice realities related to the implementation
of CCP in Tanzania and to guide the alignment of the occupational therapy curriculum towards
a local understanding of CCP or an alternative (non-Western) perspective. This study, therefore,
aimed to determine the understanding and use of CCP by occupational therapists in Tanzania.
Methodology: The study used a descriptive cross-sectional design. All qualified occupational
therapists working in different regions in Tanzania were approached to participate in the study
(N=80). A questionnaire, the Professional Questionnaire for Assessing CCP (PQACCP) was
adapted for the study. The questionnaire consisted of five sections: 1) demographic and
practice information; 2) an adaptation of an existing checklist on understanding CCP (Parker,
2006); 3) potential barriers to CCP; 4) enablers of CCP; and, 5) therapist opinions on the
relevance of CCP for the Tanzanian context. The checklist of potential barriers and enablers was
adapted from Sumsion & Smyth, (2000). Data were analysed using the SSPS software program
(version 20.0). Numerical variables were checked for normality and the appropriate measures
of central tendency and dispersion calculated. Frequencies and proportions were determined
for categorical items. The Chi-square test of association was done to determine whether there
were any observed associations between demographic variables and barriers/enablers.
Results: The top three barriers were ‘the therapist is short of time’ (n=51, 79.7%), ‘the therapist
thinks that CCP is too demanding for the client’ (n=50, 78.1%), and ‘the therapist and client have
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different goals’ (n = 49, 76.6%). The top three enablers were ‘education about CCP while still a
student’ (n = 63, 98.8%), ‘client involvement in planning of services’ (n = 62, 96.9%), and
‘involvement of all staff and service providers in CCP training’ (n = 62, 96.9%). There were no
statistically significant relationships between demographic characteristics and understanding of
CCP, barriers to CCP and enablers to CCP. There were statistically insignificant but interesting
gender differences in the identification of enablers and barriers that warrant further
exploration.
Conclusion: Tanzanian occupational therapists showed ambivalence towards CCP. They
reported that therapists have too little time to implement CCP; that CCP is too demanding for
the client to appreciate and that therapists and clients have different goals. They believe that
CCP could be advanced through education about CCP while still students, the involvement of all
staff and service providers in CCP training, and client involvement in planning their occupational
therapy Qualitatively, Tanzanian occupational therapists believe that CCP enriches the
occupational therapist-client relationship, CCP is difficult in Tanzania and CCP needs to be
supported in Tanzania. Tanzanian occupational therapist would best benefit from introducing a
range of occupational therapy practice models besides CCP because the health service context
is resource-constrained, hospi-centric and regulated by the medical model. It does not,
therefore, allow for the optimal implementation of CCP.